Robbie Post Vet Visit info

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RobbiesMom

RobbiesMom

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Hi gang
After working from 9am Tuesday to 4:30 am Wednesday morning, getting to sleep at 5am,up at 6:30 for shoot and breakfast for Robbie and than up againat 10:30 to get to work at noon at 3:40 yesterday I had the longest appt. with our vet I've ever had. He'd reviewed Robbies SS from our first bout with this issue (2 years ago) and we went over his most recent SS numbers. Here is his request to me - shoot 4/4.5 no more no less NO MATTER what the numbers are (unless they are low 100's). If I'm shooting 4.00 into 150- 180/200 he gave me his cell phone and said call him and he'll be on stand by, if I can't be around he offered we can drop Robbie off at the office for monitoring and he'll work out a low fee for me for this service and I can pay when I have the money. His feeling is Robbie has some level of resistance and what worked the first time around was basically what we would call here "over dosing" or similar. He has had this happen on numerous occasions. He does not want to put Robbie at risk but when we discussed it if I remove my tendency for hysteria/over reacting it's true that Robbie NEVER really came down THAT critically low except for ONE time when the dose was 8.00 2 years ago. SO while this is going to be VERY hard for me and a REAL pain in the ass I am going to - to the best of my ability- give this a 2 week trial. He asked for 3 weeks we compromised. His other thought is switching insulin. His main concern is he wants Robbie STEADY even if it's in the yellows. He gave him a very complete going over - his breathing is DECENT - no crackles, a mild wheeze mostly on exhale and not all the time. His heart is very strong, his respiration rate was good, his temp normal, his eyes clear (although he does feel he's having some bad allergy reactions and put him on antihistimine). Robbie had a TOTAL melt down as we ended up having to wait 25 minutes due to an emergency that came up almost as we were pulling into the vets office. He HATES being there and sitting on the counter with me holding him he began panting and seriously stressing out. They put us in a nicely airconditioned exam room early and I let him walk around. By the time the vet saw him he was curled up on the table staring out the window and was in pretty OK shape. His BG was 224 via their test. I did not have time to test him before we left for the vets (very annoyed at that) so I don't know what he was before his melt down over being at the vets.
Interesting: we saw a long haired kitty that gets shaved in like a crew cut - looked adorable and the owner said he's so much happier - wondering if Robbie would like that he gets so hot in the summer and HATES to be combed.
Another upcoming challenge. Our vet wants to do a teeth cleaning - he did a very long mouth exam at my insistence that Robbies breath is the worst it's been. He looked and agreed he needs a cleaning - even I could see with the Vets help that his gums looked a bit different than they have and he pointed out a few spots. However he does NOT want to do this during allergy season when his breathing is somewhat compromised and also would like to see his BG numbers more stable. We are thinking of doing this in Sept. but he will check his mouth again when we bring him in 2 weeks from now for blood work to see where he is.
All in all it was a good visit - I'm not sure how this "new routine" will work but I'm going to give it a shot - Our vet was about as insistent that I try this as he's ever been about anything and I do trust him, esp. after he spent a good 20 minutes going over his SS and all my notes with me.

I am hoping I can still rely on all of you for some support as we see where this goes. I'm NOT going to be looking to win BOS awards every day so this will be a challenge the first time I'm shooting 4.0 into a number I would never have considered doing this with before I know I'll be freaking out - I am also not SO sure I'll follow those guidelines that carefully - I'm not going to put my baby boy at risk. I understand the theory here after our long talk at the Vets but I'm the one pulling that trigger and than standing around sweating to see if he hypo's and our Vet understands that so we left it that "to the best of my ability" I will stick with this dose. He offered that I could pick 3.5 or something lower but he felt 4/4.5 made the most sense. He just wants him getting a uniform dose for 2-3 weeks, with food, at the same times every day. So that's the goal. Fasten your seat belts...
 
I understand, Ellen. You need to trust and use your vet so you want to honor his advice.

You have the syringe and get to decide. And you know how to monitor carefully and what to do if he goes too low. It is not something I could do. I couldn't shoot the same high amount into the lower numbers. But we will be here to help if and when you need it.

Re the teeth. It is very possible that the teeth are impacting his bg levels and may be a bigger factor than any change in dose. Some cats really go down in bg once the infection in their mouth is resolved.
 
Ellen,
I totally understand where your vet's thinking is on this, because my vet was a very aggressive doser. Her theory was to shoot high doses, and she gave me a "scale" to use. It was scary. My "advantage" over you was that at that time, I wasn't a member of FDMB, so I was nodding my head in agreement, and following her advice because I trusted her, I knew nothing about the disease, and I didn't know any better. :smile:
At times, Bob's scale ran from 1u to 4u depending on his PS numbers, and I followed that for 4 weeks or so. Her "line in the sand" was "If you get under 100, call me before shooting", and yes, Bob got a couple of shots when his BG was green (NOT THAT I WOULD EVER ADVISE ANYONE TO DO THAT!!!!).

That said, I (and I'm sure everyone else here) is with you on this. You do what you need to do, let us know what is going on, and we'll get through this trial. It could very well be the thing that will work. Maybe you have to overcome Robbie's resistance to insulin, and a two week experiment with "BAM" doses (as we call them) is what is necessary. It's going to stress the hell out of you, but that's where we come in. Just keep us all in the loop so we understand what's happening and can try to help in any way we can.

The teeth cleaning is a good idea. I can't remember who the kitties and beans were right off the top of my head, but several people have had a breakthrough once a dental was done. I thing "Sev" and his guy "Kitty" were one case maybe? I think Donna and Asher as well.

Bottom line - we're in your corner,
Carl
 
Thanks Sue and Carl - means the world to me to have support even if I"m going down a path not generally followed here. Like I said - we'll see what I can bring myself to do - this morning I gave him 4.5 when he was 329 and at +5 he was 183.
I have to say a bit thank you to Robin who took her time to do the sliding scale for us - only to have me stop following it a week later - but I still have it posted and am going to use it as a guideline to judge just HOW far off I am going by sticking to 4.5.
I know this will give me some sleepless nights (what else is new) and more anxiety at a time when I really could use less but if it gets him to a better place it will have been worth it.
As for his teeth - the vet wasn't happy with them but also wasn't that worried - said "they need to be cleaned soon, not right away but yes, they could use some help soon" - I wonder if there's kitty tooth brushes like they have for dogs? My husband brushes the darn dogs teeth monthly- they sparkle. LOL
 
That's a good drop to +5, but still really safe. I think the big thing you'll have to deal with is not necessarily scary low numbers, but the bounces from dropping lower than he's used to. It sounds like the vet is thinking "screw the bounces, I ain't worried about them" in the hope that he'll eventually just stop bouncing. I think what ended up happening with Bob was that his liver just got tired of fighting the insulin and said "screw the insulin, I'm tired of bouncing". ;-) So he's just telling you to turn a blind eye on the PS numbers and stick with a dose. Unless you get really low numbers at shot time, of course. When it will bother you is when you get a 200ish number. And at that point, you may be able to use food in the +3 to +5 range to prop up his BG and stop him from going too low. We'll get to that when we get there...

Carl
 
You're probably right Carl and he also looked at some of the days I gave more than 4.5 and said "you're bouncing him" as well as the days when things were really low and I shot less cause His ps number was low - and said "and you're bouncing him here too" so he feels "consistency" and even numbers are "better" for the cat than trying for lower numbers all the time - at any rate he sure as hell bounced today - gonna test him in about an hour tonight +4 - Vet also suggested not testing so much - give myself and Robbie a break so I"m not doing any curves or as much testing for a while either. I'm trying to test at shot time and near nadair and leaving it at that.
 
My only suggestion would be to test around +4 or +5 as a routine, and that way you'll have an idea of if he's likely to go really low by +6 and needs watching. Other than that, I think testing 3 or 4 times in 24 hours is okay. I didn't test Bob often enough if anything. Most days it was just the PS tests (again, because I didn't know better) and at most, one time during the AM cycle around nadir.

Carl
 
KICKING myself. I ordered some test strips off ebay - 100 of them plus I had a thing of 50 from my own prescription - I "hid" the 50 for emergency use - I cannot believe I went thru the 100 already (but I do test alot and my husband gets lots of false tests cause he just doesn't have the hang of it) so here I am with 4 test strips - thank god Robbie doesn't appear to be anywhere near going too low tonight but I cannot believe I can't find the 50 I hid - I can only think I used them too? Or I'm losing my mind? I've checked all my "hiding" spots and nothing. So tomorrow I go and pay full price for some - I ordered 150 off of ebay but they won't be here till Saturday- UGH I hate this.
 
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